Background:Approximately 3 to 4 billion people worldwide are exposed to household air pollution, which has been associated with increased blood pressure (BP) in pregnant women in some studies.Methods:We recruited 3195 pregnant women in Guatemala, India, Peru, and Rwanda and randomly assigned them to intervention or control groups. The intervention group received a gas stove and fuel during pregnancy, while the controls continued cooking with solid fuels. We measured BP and personal exposure to PM_2.5, black carbon and carbon monoxide 3× during gestation. We conducted an intention-to-treat and exposure-response analysis to determine if household air pollution exposure was associated with increased gestational BP.Results:Median 24-hour PM_2.5 dropped from 84 to 24 μg/m³ after the intervention; black carbon and carbon monoxide decreased similarly. Intention-to-treat analyses showed an increase in systolic BP and diastolic BP in both arms during gestation, as expected, but the increase was greater in intervention group for both systolic BP (0.69 mm Hg [0.03–1.35]; P=0.04) and diastolic BP (0.62 mm Hg [0.05–1.19]; P=0.03). The exposure-response analyses suggested that higher exposures to household air pollution were associated with moderately higher systolic BP and diastolic BP; however, none of these associations reached conventional statistical significance.Conclusions:In intention-to-treat, we found higher gestational BP in the intervention group compared with controls, contrary to expected. In exposure-response analyses, we found a slight increase in BP with higher exposure, but it was not statistically significant. Overall, an intervention with gas stoves did not markedly affect gestational BP.

中文翻译：

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液化石油气炉干预对妊娠血压的影响：HAPIN 试验的意向治疗和暴露反应结果


背景：全世界大约有 3 到 40 亿人暴露在家庭空气污染中，一些研究表明这与孕妇血压 (BP) 升高有关。方法：我们招募了危地马拉、印度、秘鲁和卢旺达的 3195 名孕妇并将他们随机分配到干预组或对照组。干预组在怀孕期间使用煤气炉和燃料，而对照组则继续使用固体燃料做饭。我们在怀孕期间测量了血压和个人接触 PM _2.5 、黑碳和一氧化碳 3 倍的情况。我们进行了意向治疗和暴露-反应分析，以确定家庭空气污染暴露是否与妊娠期血压升高相关。结果：干预后，24 小时 PM _2.5中位数从 84 下降至 24 μg/m ³ ；黑碳和一氧化碳也同样减少。意向治疗分析显示，妊娠期间双臂的收缩压和舒张压均有所增加，正如预期的那样，但干预组的收缩压增加幅度更大（0.69 mm Hg [0.03–1.35]； P = 0.04）和舒张压（0.62 mm Hg [0.05–1.19]； P = 0.03）。暴露反应分析表明，较高的家庭空气污染暴露与较高的收缩压和舒张压有关；然而，这些关联均未达到传统的统计学显着性。结论：在意向治疗中，我们发现干预组的妊娠血压高于对照组，这与预期相反。在暴露-反应分析中，我们发现暴露较高时血压略有升高，但不具有统计学意义。总体而言，燃气灶干预并未显着影响妊娠血压。